Healthcare Provider Details

I. General information

NPI: 1942281670
Provider Name (Legal Business Name): LINDA S BUTTERWORTH GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST AVENUE SOUTH
LA CROSSE WI
54601
US

IV. Provider business mailing address

800 WEST AVENUE SOUTH
LA CROSSE WI
54601
US

V. Phone/Fax

Practice location:
  • Phone: 608-791-9875
  • Fax: 608-791-9494
Mailing address:
  • Phone: 608-791-9875
  • Fax: 608-791-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number595
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: